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Provider Update Newsletter

This is the workhorse in our communications stable of materials. We launched our first edition in October 2020. It is delivered to all providers electronically each month. This communication vehicle covers essential operational and procedural topics to help you do business with Buckeye. It will also deliver training and education opportunities and include some of Buckeye's provider-based initiatives. All editions of the newsletter will be available on the website.

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Welcome to the February 2021 Provider Update Newsletter

 

COVID Vaccine Updates

  • See our new Medicaid COVID Vaccine page with the latest information.
  • Be sure your patients know about the upcoming ODH webinars, starting February 22.
  • Ohio has over 700 providers across all 88 counties to ensure access close to home. Buckeye’s partnership with Federally Qualified Health Centers and nursing homes, as well as personalized outreach to members, add up to Ohio COVID Champions.

 

Don't Miss Anything - Sign Up for Provider Communications

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

 

CMS Removes Inpatient Only List Starting in 2021
Medicare Only – Allwell and MyCare

CMS has announced the finalization of their rule to end the inpatient-only list. This transition will occur over a three-year period and begins by eliminating about 300 services, mostly musculoskeletal-related in nature (including joint replacements). See the details.

 

Navigating the process for hospital level of care approval and denials.

A Step-by-Step Guide.

To assist you in navigating the process of receiving approval or denial for the level of care you request for admission to a hospital, long-term acute care facilities, rehabilitation facilities and skilled nursing facilities, we created this Step-by-Step Guide.
 

Q1 2021 CPC Payments Mailed Week of 2-8-21

The first quarter 2021 Comprehensive Primary Care payments, reflecting attribution from third quarter 2020, were mailed to the applicable providers the week of 2-8.

If you have not yet received it, please check to see if your postal address is current in MITS.  

 

National Eating Disorder Awareness Week - February 22-28, 2021

Though most commonly associated with women, eating disorders can impact people of all genders, ages, race, ethnicities and body shapes. They can onset from biological, as well as psychological factors. To better understand these disorders, read our February article
 

EVV Training

The Ohio Department of Medicaid (ODM) webinars:

  • February: General EVV Q/A
  • March: Overview and Updates for Case Manager

See details.

 

HEDIS Measure Deep Dive: Appropriate Treatment for Upper Respiratory Infection

Typically, antibiotics are not recommended for upper respiratory infection, as these are usually viral in nature. Research has shown...See Details

Growth Opportunities & Resources for Teens

Buckeye Health Plan provides growth opportunities and resources to support the healthy development of young people ages 13 – 19 years old through Centene’s industry leading, national initiative, Strong Youth Strong Communities (SYSC℠). SYSC partners with the Pro Football Hall of Fame and other national youth serving organizations to offer in person and virtual summits covering topics such as:

  • Stay Smart: education and career development;
  • Stay Safe: cyber safety and healthy relationship skills;
  • Stay Paid: financial literacy;
  • Stay Ahead: leadership development; and
  • Stay Well: supports for mental and physical health and wellness.

These resources and more, including videos of virtual SYSC summits, are now available on the SYSC website and mobile apps. 

 

2021 CPT Code and Guideline Changes for Office/Outpatient Visits - Medicare Only

The New Year has ushered in notable changes for evaluation and management (E/M) services that will impact most, if not all, providers. Designed to reduce physicians’ administrative burden and facilitate increased time with patients, these changes, with respect to office/outpatient evaluation and management (E/M) services, are as follows:

I. CPT Code Changes

A. CPT code 99201 has been deleted

B. Code titles for CPT codes 99202-99215 have been revised. References to the history and exam as required components for service level selection have been removed and replaced with instructions to document “a medically appropriate history and/or examination.” 

II. Changes to Service Level Selection

  • The level of service is now selected based on medical decision making or time. Medical decision making (MDM), a familiar concept for providers, has seen the implementation of a few changes meant to shift focus toward tasks that affect patient management. Meanwhile, the guidelines for using time to level an office/outpatient visit have changed to a significant degree.

1. Firstly time can now be used to level all office/outpatient visits; counseling/coordination of care no longer has to dominate the encounter.

2. Secondly providers’ total time on the day of the encounter now determines the service level, not just face-to-face time with the patient. Examples of non-face-to-face time include time providers spend performing activities such as reviewing patient tests; ordering medications, tests, or procedures; referring and communicating with other health care professionals; and documenting clinical information in the health record.

3. Lastly the typical time associated with a code is now redefined in terms of ranges of minutes.

While the history and exam do not impact the level of service in 2021, neither should be eliminated altogether from 2021 progress notes. CMS has offered some guidance, stating, “It remains our expectation that practitioners will document E/M visits as necessary to ensure quality and continuity of care.”

Welcome to the January 2021 Provider Update Newsletter

Happy New Year!

Buckeye hopes you and your families had a safe and enjoyable holiday season. We look forward to working with you in 2021 to continue building our partnership and make working with us as easy as possible. We welcome any thoughts or ideas you have to help us help you, please feel free to let us know.

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

ODM January 2021 EVV Training – Home Care Providers

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. See more details and register for training.

Phase 3 training was required by December 31, 2020. However, the Ohio Department of Medicaid (ODM) and Sandata are hosting Electronic Visit Verification (EVV) webinars in January 2021. The webinars will focus on best practices related to EVV maintenance and ensuring visits are accurately captured to support claims. Please use the links below to register. After registering, you will receive a confirmation email containing information on joining the webinars. If you are unable to attend a live webinar, a recording will be posted to the Webinar tab on the ODM website after the first hosted webinar. 

Be Successful with EVV

  • January 26, 2021, 3:00 to 4:30 p.m. Register
  • January 29, 2021, 2:30 to 4:00 p.m. Register

New Feature: Behavioral Health Video Series

Each month during 2021 we will feature an aspect of Behavioral Health in our Provider Update newsletter. The information is intended to help you help your patients. These will include a video from Dr. Pelt, Buckeye Health Plan BH Medical Director and may also include articles and/or other materials to support our providers.

January is highlighting Substance Use Disorder. We are pleased to share a video from Dr. Pelt and a helpful article on how Buckeye is addressing the opiate crisis. 

In addition, we are sponsoring free training on The Treatment of Opioid Use Disorder delivered by ASAM. This 2 part course:

  • covers all medications and treatments for opioid use disorder
  • provides 8 hours of required education needed to obtain the waiver to prescribe buprenorphine in an office-based setting.
  • qualifies for CEU credits

Part 1: Online course due: February 4
Part 2: Virtual Live 4 hour Course on February 5

Register today for this free training!

Diabetes Self-Management Education Program is now covered by Buckeye Health Plan for Medicaid members

The DSME program can create positive changes in health behaviors and improve diabetes-related outcomes such as: hemoglobin A1C levels, BP, Cholesterol. It also results in healthier lifestyle behaviors and fewer hospital admissions and readmissions. See more details.

Buckeye Care Management Team Leads With Heart

Buckeye’s Vision is to transform the health of the community, one person at a time. It guides our care management team as they work with members, like Brian, who have complex physical and mental health conditions. Thanks to Buckeye, Brian is managing his conditions and actively enjoying the art and music he loves.

Watch the video to learn more about Brian’s health journey.

You are an important part of the team that surrounds and supports Buckeye members. We are grateful for your partnership. 

Talking to Your Patients About the COVID-19 Vaccine

Patients look to their healthcare professionals for medical guidance and assurance about the COVID-19 vaccine. Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.

It may be helpful to refer your patients to the links below to help them understand that the COVID-19 vaccine is safe, effective and provided free of charge.

Coronavirus.ohio.gov
Centers for Disease Control and Prevention

In addition, we maintain a provider COVID section on our website. You can find billing information, talking points, FAQs and the latest information. Thank you for your partnership in keeping our members, your patients, safe. Together we can stop the spread.

 

Welcome to the December 2020 Provider Update Newsletter

Wishing You a Happy and Safe Holiday Season

As we put 2020 in our rear-view mirror, Buckeye would like to recognize and thank our providers for the extra care and service you’ve given as many of our members struggled to meet basic needs in addition to maintaining their health during this unprecedented year. Thank you for partnering with Buckeye on many initiatives that went beyond healthcare. We are grateful that together, we have built a safety net that helped support our members during tough times.

Buckeye Leads with Heart in everything we do and remains focused on our core values of compassion, connection authenticity and accountability. This starts at the top with our President and CEO Steve Province, and extends through all aspects of the company. Steve shares a brief thank you message on behalf of all of Team Buckeye.

Holiday Hours

Our Provider Services is open every weekday from 8 a.m. to 5 p.m. throughout the holidays, except: 12-25-20 and 1-1-20. 

Holiday Check Runs

  • CBH-Checks issued Tuesday December 22 for  the week of Christmas
    CBH-Check issued Tuesday December 29 for the week of New Year’s
  • Medicare-Checks issued Tuesday December 22 for  the week of Christmas
    Medicare-Check issued Tuesday December 29 for the week of New Year’s
  • Medicaid (no changes)

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

COVID-19 Updates

Mental Health During the Holidays - Tips to Share With Older Patients  

Buckeye is raising awareness about the mental health challenges that many older adults face this holiday season. We ask you to offer encouragement to older adults to help them cope during this challenging time of isolation required by COVID safety measures. Here are signs of declining mental health and tips to share about how to stay healthy:

Signs that mental health may be deteriorating:

  • Deep boredom, general lack of interest and withdrawal
  • Losing interest in personal hygiene
  • Poor eating habits and nutrition
  • Significant disrepair, clutter and hoarding at home

Ways to stay healthy:

  • Call, text or video chat with family and friends often
  • Exercise, as physical activity – it’s good for body and mind
  • Read a book or play games to keep your mind fresh
  • Cook healthy dinners and share recipes online with family and friends
  • Catch up on a TV series or watch an upllifting movie

If someone is experiencing depression or other mental health issues – especially during the holidays when so many others are feeling joyous, it’s important that they acknowledge those feelings and reach out for support. Let them know that help is readily available:

  • Talk to their doctor
  • Call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357).
  • Access Buckeye’s free online tool called Buckeye Community Connect to quickly and easily find free or low-cost resources and services by zip code for mental health services and medical care, food, housing, transportation and much more.
  • Buckeye offers a behavioral health crisis line and telehealth services to support members' needs. Call 1-866-246-4358 and press * to be connected to a behavioral health specialist.


Announcing a 2021 Behavioral Health Video Series

Buckeye will launch a new video series to supplement our newsletter focus on Behavioral Health. Each video will be about three minutes long and will address important topics such as: bullying, social isolation/social inclusion, eating disorders, Autism, PTSD, senior mental health awareness and anxiety disorders.

Look for our first video in our January 2021 Provider Update Newsletter.


Pediatric ECHO Seminars

Starting in January 2021, Buckeye is partnering with Nationwide Children’s Hospital to offer healthcare professional access to two new Project ECHO seminars:

  • Primary Care: Foundations Series
  • Advanced Series: ADHD in Primary Care

To register and more details go to their website.   

For any questions, please email ProjectEcho@nationwidechildrens.org directly.

What is Project ECHO?

  • Project ECHO is a learning collaborative that helps healthcare professionals acquire skills to manage children with behavioral health conditions presenting in primary care office.
  • This interactive, case-based learning is focused and didactic. 
  • It is held during the lunch hour and provides opportunity to earn CME credits.
  • The program will present cases and invite questions to the interdisciplinary team (Hub) and other primary care providers (Participants) via video conferencing (Zoom)

Why Child Behavioral Health ECHO?

  • There is a critical shortage of Behavioral Health specialists
  • Children often talk with their primary care provider for help with behavioral health
  • We aim to support and enhance the capacity of primary care providers through collaboration with experts and collective wisdom of the primary care community

What to expect during an ECHO session

  • Participate in a 60-minute session (4 sessions)
  • Scheduled to meet on Thursdays between 12 and 1 PM 
  • Submit a case to present to the group and engage in interactive discussion
  • Collaborate with the expert team in providing recommendations

Ambetter 2021 Expansion

Buckeye’s Marketplace Exchange health plan, Ambetter, will be available for members in 27 additional Ohio counties for 2021. Ambetter delivers the high quality, comprehensive coverage that your patients deserve. This coverage offers valuable programs and educational tools for your patients, making it easier for them to stay in charge of their health. We look forward to partnering with you to improve the healthcare outcomes of our members.

You can see our Ambetter expansion counties on our Ambetter Plans on the website. If you have already joined the Ambetter network and would like to participate in an Instructor-Led Orientation, please see our Training page.  These one-hour webinars discuss the Ambetter plan, claims, authorizations, web access, reference materials and key contacts at Buckeye Health Plan.

If you have any questions, please contact Provider Services.

Introducing Buckeye’s Provider Accessibility Initiative

Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.

Member Transportation Benefit Includes Access to Food

Buckeye offers member transportation, at no cost to them, that help members get to medical, dental and vision appointment. Did you know they also provide transportation for non-medical reasons, such as access to food?  See more details and other non-medical reasons.

Practitioners & Groups Must Enroll with ODM Prior to January 2021.

All providers who currently contract with or wish to contract with a Medicaid managed care plan (MCP) must be enrolled with the Ohio Department of Medicaid (ODM) prior to January 2021 or your claims will deny. This includes any practitioner or group practice that bills for or renders services. ODM requires professional medical groups to be enrolled as outlined in their memo.

Important EVV Reminder – Phase 3 Training Required 
by December 31, 2020

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. 

The Ohio Department of Medicaid (ODM) is implementing Electronic Visit Verification (EVV) for some home and community-based services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). EVV is an electronic system that verifies key information about the services provided. In accordance with the Cures Act, the system implemented by ODM will record the date of the service, the time the service started and ended, the individual receiving the service, the person providing the service and the location of the service. Both agencies and non-agency providers are impacted by EVV.

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. A full listing of the services can be found on the Phases tab on the below link.

Medicaid Initiatives - EVV Phases

Also, please see sections on the link for Individual and Provider training.

 

Welcome to the November 2020 Provider Update Newsletter

Thank you for all you do!

In this season of giving thanks, Buckeye would like to thank our valued providers for the exceptional care you give our members. We appreciate your partnership in delivering high-quality and compassionate care for the best possible outcomes. We wish you and your families a safe and enjoyable holiday.

Holiday Hours

Our Provider Services will be closed Thursday and Friday, November 26 and 27, 2020 in observance of the Thanksgiving holiday. Please let us know if you have any questions.

Provider Communication Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us. Please sign up for Provider Communications. Even if you have received our email communications in the past, please sign up for future communications.

Flu Shot Reminder: You can make a difference! Help your patients get their flu shot.

  • Make a strong recommendation to your patients to get their flu shot. Research shows that patients are more likely to get a flu shot if their doctor recommends it.
  • Follow-up is important! Talk to your patients about where and when they’ll get their flu shot, and make a note to confirm during their next visit.
  • Talk with your patient about any questions or concerns — and be sure to repeat your strong recommendation. Most people know the flu shot is important. They may just need your reminder!

See our Fluvention page on our website for more details and Talking Points.

Ambetter 2021 Expansion

Buckeye’s Marketplace Exchange health plan, Ambetter, will be available for members in 27 additional Ohio counties for 2021. Ambetter delivers the high quality, comprehensive coverage that your patients deserve. This coverage offers valuable programs and educational tools for your patients, making it easier for them to stay in charge of their health. We look forward to partnering with you to improve the healthcare outcomes of our members.

You can see our Ambetter expansion counties on our Ambetter Plans on the website. If you have already joined the Ambetter network and would like to participate in an Instructor-Led Orientation, please see our Training page.  These one-hour webinars discuss the Ambetter plan, claims, authorizations, web access, reference materials and key contacts at Buckeye Health Plan.

If you have any questions, please contact Provider Services.

Utilization Management Updates 

  1. PA Authorization requirements changes for long term acute care facilities (LTAC), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF hospital). Link will take them to content below.
  2. Re-routing calls to better support our providers.
    Delivering the best possible customer service for our providers is a top priority for Buckeye. During this unprecedented pandemic time we are experiencing a significant increase in calls regarding our authorization requests. Therefore, our UM and Provider Service (PS) departments have combined forces to best meet your needs.

UM will continue to take the calls listed below:
-- Authorization date changes that cannot be faxed
-- Authorization needed that was initiated by Emergency Room visit
-- Questions regarding additional clinical information for a request for service
-- Questions about a denial

UM Department: 1-866 246-4359 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)


Our Provider Services representatives are standing by to assist you with the following calls:
-- To start or check an authorization*
-- Authorization status checks
-- Requesting a care manager
-- Appeal status or questions
-- Assistance with our online Prior Auth Code Check Tool*
-- Provider portal questions
-- Claims*
-- Member benefits*

Provider Services: 1-866-296-8731 M-F, 8 a.m. to noon and 1 to 5:00 p.m. (closed noon to 1:00 p.m.)

* Self-Service tools on our provider portal.

Warm transfers between UM and Provider Services will be provided, as needed. We hope this change will help us to quickly address the needs of our providers.

       3. Medicare 2021 Prior Authorization List has been posted to the
           Prior Authorization page of our website.

Introducing Buckeye’s Provider Accessibility Initiative

Buckeye is working to remove barriers our members may have accessing provider locations. We want to enable our members to view provider location’s disability access information so they can find a provider based on their own disability access needs. For this initiative to work, we need to hear from you.

Member Transportation Benefit Includes Access to Food

Buckeye offers member transportation, at no cost to them, that help members get to medical, dental and vision appointment. Did you know they also provide transportation for non-medical reasons, such as access to food?  See more details and other non-medical reasons.

Buckeye Health Plan Raises Awareness for Breast Cancer

Breast cancer is the second most common cause of cancer-related death for Ohio women. But when it’s detected early, most breast cancer can be treated successfully. We encourage age appropriate mammograms and Buckeye can make access easier. Download a Mammogram Infographic for your patients.

Practitioners & Groups Must Enroll with ODM Prior to January 2021.

All providers who currently contract with or wish to contract with a Medicaid managed care plan (MCP) must be enrolled with the Ohio Department of Medicaid (ODM) prior to January 2021 or your claims will deny. This includes any practitioner or group practice that bills for or renders services. ODM requires professional medical groups to be enrolled as outlined in their memo.

New Patient/Client Liability Reconciliation Form

We strive to find ways to make working with Buckeye Health Plan easier. To assist in the reporting of PL errors or discrepancies for claims paid by Buckeye Health Plan we have created an easy to use Reconciliation Form and instructions for your use.

Important EVV Reminder – Phase 3 Training Required
by December 31, 2020

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. Phase 3 includes self-directed services and other services necessary to meet the requirements of the Cures Act. 

The Ohio Department of Medicaid (ODM) is implementing Electronic Visit Verification (EVV) for some home and community-based services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). EVV is an electronic system that verifies key information about the services provided. In accordance with the Cures Act, the system implemented by ODM will record the date of the service, the time the service started and ended, the individual receiving the service, the person providing the service and the location of the service. Both agencies and non-agency providers are impacted by EVV.

As of January 1, 2021, all providers who are providing Phase 3 EVV-eligible services must be using EVV. A full listing of the services can be found on the Phases tab on the below link.

Medicaid Initiatives - EVV Phases

Also, please see sections on the link for Individual and Provider training.

Enhancements to Claims Payment Processes

You asked and we listened. We received requests from providers for Negative Balance Reports to assist in reconciling your accounts. Now, providers will be able to identify from which payment the Negative Balance was carried forward.

Prior to Oct. 23, 2020, the Provider Level Adjustment (PLB) did not provide sufficient information for you to auto-post remittance advices (explanations of payment in electronic format) also known as 835s.

  • We have made an enhancement of the Forwarding Balance within the 835 PLB segment to include the trace number of the Negative Balance to allow you to auto-post Negative Balance 835s.
  • In addition, Offsets within the 835 now contain the patient control number and the provider’s patient account number to allow you to auto-post an Offset to your balance.

These enhancements will significantly reduce issues with Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT), and increases provider self-service. You will no longer need to request Negative Balance reports in order to auto-post an ERA.

Please note: These enhancements do not apply to Negative Balances and Offsets prior to Oct. 23, 2020.

Welcome to the October Buckeye Provider Update Newsletter

We believe that communication is vital to a successful partnership and our goal is to establish a plan to communicate essential information to make working with Buckeye easier. For easy access and reference, we’ll store the communications in the Provider Communications page of our website.

To help streamline the number of communications and better categorize the information for your use, we will be introducing new provider communication categories over the next few months.

  • Provider Update Newsletter: delivered on a monthly basis, this will be latest in operational changes, processes and procedures. We’ll also throw in some strategic initiatives and opportunities for you to partner with Buckeye.
  • Provider Notices: specific notices from ODM, CMS or Buckeye operations/policies that you need to know, but can’t wait for the newsletter.
  • Provider Alerts: urgent information that needs immediate reporting to our valued providers.
  • Special Announcements: positive information worthy of creating a spotlight to showcase exciting company and community-based activities.

Our hope is that you find these communications both helpful and easy to use. We want to make your job easier, so we welcome your feedback and suggestions and look forward to connecting with you!

Provider Update Newsletter Sign-up Form

Whether you are an office manager, clinical staff, physician, billing or front desk worker, or serve in another role within our provider locations, Buckeye would like to share relevant, timely information that makes it easier to do business with us and partner together in service to our members and communities. Please go to our Provider Communications Sign-Up Form and let us know if you have questions. Even if you have received our communications via email in the past, please sign up for future communications. We’ve gathered email addresses from various resources, but may not have your other information we need to customize specific messages in future communications.

HEDIS - Q4 Targeted Measures

COVID-19 continues to impact our members and providers. We are seeing significant declines in the number of members who are making preventative care appointments with their PCPs.  We need your help to close all 2020 gaps in care. Please review your patient records and contact Buckeye members who have missed appointments – particularly those who are not compliant on HEDIS-related measures. Buckeye is here to help. Remind them we offer:

  • Transportation to and from provider offices for well-care and treatment; and trips to the pharmacy for medications.
  • No-cost telehealth visits for patients who may have transportation or health related barriers to making an in-person visit.

Your Buckeye provider representative is here to help you identify ways to reach members and close care gaps. If you are unsure who your representative is, please contact Provider Services at 866-296-8731.

Targeted HEDIS measures for Q4 2020. You can find the full descriptions on our website:

  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Post-Partum Care
  • Adult Access
  • Child Access
  • Immunizations
  • Annual Dental Visit
  • Comprehensive Diabetes Care:  HbA1c (Poor Control, Testing), Eye Exams, Blood Pressure
  • APM, SMC, SMD, SDD
  • COA, COL, PCR, MDS

We value our partnership and thank you for your continued support.

New COVID-19 Telehealth Guidelines

In order to ensure that all Ohio Medicaid members have needed access to care, the Ohio Department of Medicaid (ODM) and Medicaid Managed Care Plans (MCPs) are increasing the scope and scale of reimbursement for telehealth services for Medicaid recipients during the duration of the COVID-19 emergency. These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to reduce their exposure in public settings. Through collaboration with providers and ODM, the short-term goal of the MCPs is to expand access to critical patient care through the time of emergency, with the overarching goal of creating a future state centered on sustainability and person-centered quality metrics. See the MCP Telehealth Policy and Provider Telehealth Resource Guide.

A network that provides seamless COVID-19 care for your patients.

LOB: Marketplace and Medicaid PCPs
The COVID-19 global pandemic has created unprecedented changes to our lives and healthcare systems. While we continue to connect our members to COVID-19 services, we want to reach out to our provider partners on how we can work together to better support their care needs. As a primary care physician (PCP), you are at the heart of our members’ healthcare. They trust and rely on you See More

October is Mental Health & Breast Cancer Awareness Month

Mental Health Awareness

Each year, millions of Americans face the reality of living with a mental health condition. However, mental illness affects everyone directly or indirectly through family, friends or coworkers. Despite mental illnesses’ reach and prevalence, stigma and misunderstanding are also, unfortunately, widespread (NAMI, 2020). Read: The Impact of Stigma on Substance Use Disorders

Buckeye Encourages Breast Cancer Screenings During National Awareness Month

In honor of Breast Cancer Awareness Month, Buckeye is encouraging Ohioans to get their breast cancer screenings. Because some Ohioans may fear exposure to COVID-19 by visiting their doctor, it’s important for physicians offices to reach out to patients and encourage them to get this important screening. “Getting a mammogram has never been faster or easier,” said Dr. Brad Lucas, Buckeye’s chief medical officer. “It takes 30 minutes or less and can give your patient peace of mind.”

Flu Prevention: You can help stop the flu!

Strongly recommend to all of your patients to get their annual flu shot.

You have a key role to play in recommending that your patients get the flu shot.  Buckeye Health Plan is here to help. See our Fluvention Campaign page here.

Important events and educational offerings from ODM and our partners:

ODM

As you may know, efforts are underway to assist providers in becoming fully compliant with Ohio’s EVV requirements. The webinars scheduled for October and November are part of that effort.

Auto-verification of visits occurs when no provider action is necessary after the visit is recorded at the time of service. All required information is captured and no exceptions are posted.  Join us at one of the following webinars to learn more about auto-verification, why exceptions post to your visits, and how to achieve auto-verification of your visits.

Webinar (Link)                    Date/Time                                         

Streamlining EVV Workflow    Tuesday, October 27, 2020, 3:30pm – 4:30pm EST      

Streamlining EVV Workflow    Tuesday, November 3, 2020, 2:30pm – 3:30pm EST 

Streamlining EVV Workflow    Friday, November 6, 2020, 10:00pm – 11:00pm EST 

Please share this information with others who may be interested or benefit from the webinars.

OAAP 

Free Virtual Event:
2020 Reversing the Trend of Irreversible Actions - Store It Safe Virtual Fundraiser
November 20th: 11:30 AM-1:00 PM

Interdisciplinary panel on teen suicide prevention -- Featuring Injury Prevention Medical Directors Dr. Mike Gittelman and Dr. Sarah Denny plus Denise Meine-Graham from Franklin County Loss. Also back this year, due to overwhelming requests from former attendees, is teen advocate, Jeremy Hardjono!

This message is so important and timely that we have decided to make the event FREE for all to attend.  It is essential that we all learn more about teen mental health and safe storage practices to prevent suicide. Register here. While you’re there, check out the Buckeye Health Plan Virtual Exhibit.

Ohio AAP is now offering LIVE VIRTUAL versions of in-office MOBI & TIES!

These enhanced trainings offer the same content as our traditional MOBI & TIES, while also adding in COVID-19 information, with a focus on provider and practice guidance during and post-pandemic. 

Our virtual MOBI & TIES include:

  • Guidance on continuing immunization best practices
  • Epidemiology & background of COVID-19
  • Practice operation guidance in a pandemic (i.e. telehealth)
  • 1-hour CME for each session

Please contact Lory Sheeran Winland, Director of Immunization Programs, at lwinland@ohioaap.org to request a live virtual MOBI and/or TIES.

Nationwide Children’s Hospital (NCH)

Project ECHO – Advanced Series: Eating Disorders in Primary Care (register by 10-26)
October 29: Noon to 1:00 p.m., Prevention and Identification of Eating Disorders in Primary Care

November 12: Recognize and Refer Eating Disorders in Primary Care

  • Learn to differentiate between eating disorders
  • Learn preventative measures for use within your practice
  • Understand assessment and treatment options in primary care setting
  • Compile resources and referral information to your practice and patients

For more details and to register by October 26

Project ECHO – Advanced Series (2 parts): Gender Dysphoria in Primary Care
November 5: Noon to 1:00 p.m.  Emotional and Behavioral Health of Today’s Genderation ” of Children and Adolescents: The Role of the Pediatrician and Primary Care Providers

November 19: Gender Affirming Medical Care

  • Learn relevant terminology with respect to gender and sexuality constructs
  • Learn ways to create a welcoming office environment for gender diverse patients and families
  • Understand non-medical and medical options for treatment
  • Compile resources and referral information for your practice and patients

For more details and to register by November 3

New Opioid Program

As part of the initiative to combat the opioid epidemic, Buckeye Health Plan has adopted a Drug Management Program (DMP) for beneficiaries at-risk for misuse or abuse of frequently abused medications. Learn more about Use of Opioids from Multiple Providers.

Partnership with Mercy Health Overcomes COVID Barriers to Preventive Health Checks

Challenge: Encourage Buckeye members who have chronic health conditions to complete their annual preventative visit with their PCP.  Read about our successful outcome!

Good News for our Ambetter OB/GYNs

In our goal to make working with us easier, we’re pleased to announce that Buckeye has removed the PA requirements for OB-Ultrasound. As of September 24, 2020, participating OB/GYNs will no longer need to submit an OB prior authorization for OB-Ultrasounds. Non-participating providers must continue to submit the prior authorization and receive approval before services are rendered.

Buckeye Partners With Lower Lights CHC to Pilot New Healthy Food Rx Program

Did you know that Buckeye partners with providers across Ohio to offer programs that help our members overcome obstacles to care and social determinants of health?  In 2020, we partnered with Lower Lights Christian Healthcare Center, an FQHC in urban Columbus, to successfully pilot a Healthy Food Rx program for adult Medicaid members who have chronic health condition. The program provides nutrition education and healthy food each month. We are looking to expand our program in 2021. Read more details, see an inspiring video journal and let us know if you’d like to partner with us next year.

Buckeye Cares for the Whole Person

Medical care is a top priority, but at Buckeye we work to meet the many needs that may impact our member’s ability to access that care. We want to ensure services are provided that meet the needs of the whole person. Check out our programs that go the extra mile to care for our members.  

BH Utilization Management - When to use ASAM

As announced by Ohio Department of Medicaid, they have a new requirement to ensure clinical consistency and coverage of Medicaid services across the full ASAM continuum. To make things easier, Buckeye has summarized the new requirement and created a form to help guide you.